Reference to this model has been made in Chapter 1 of this thesis (see section 22.214.171.124) as a foundation framework for the Health Decision Model. The health decision model combines the health belief model and patient preferences including decision analysis and behavioural decision theory.
121 The HBM can account for self-monitoring behaviour that is; the practice appears to be associated with positive benefits for patients in helping alleviate some of this anxiety. Perceived health is also an important predictor for patients who may go through this rational decision process where patients focus on their perceived risks of blood pressure related illnesses. It seems that the decision to self-monitor BP is pursued in order to avoid such consequences (i.e. Stroke, heart attack and death). This describes the concept of perceived risk and has been associated with several protective behaviours such as mammography screening 214 and influenza vaccinations. 215 Hyman and colleagues 213 (study described above) found that some of these women with a family history of breast cancer, that is, higher susceptibility, were also less likely to attend for screening. This is contrary to the health belief model, but also similar to the present study results. Patients who were aware of their fluctuating high blood pressure would not go and feed this back to their doctor. An explanation for this phenomenon could be provided by the Protection Motivation Theory, 216 a model that predicts when a threat occurs, people cope in a way to minimize the threat. That is, ‘ fear ’ is an additional intervening variable between perceptions of severity and vulnerability. In the context of SMBP, it appears that the level of appraised threat drives this protective health behaviour, despite this behaviour not actually reducing the threat or protecting the individual. The model is illustrated in Figure 5 and bases itself on the constructs of the HBM. ‘ Coping appraisal ’ in the model, focuses on the coping responses available to the individual to deal with the threat. Factors such as following behavioural advice are proposed to potentially increase and decrease the probability of an adaptive response.
122 Both the belief that the recommended behaviour would be effective in reducing the threat response efficacy (similar to Bandura’s construct of ‘ outcome expectation s’ ), and the belief that one is capable of performing the recommended behaviour, self- efficacy , (described later in the chapter) are proposed to also increase the probability of an adaptive response. The two appraisal processes result in ‘protection motivation’ (i.e. int ention to perform a recommended behaviour), a positive function of perceptions of severity, vulnerability, response efficacy and self-efficacy. ‘ Protection motivation ’ therefore operates as a mediating variable between the threat and coping appraisal processes and protective behaviour.
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